Papillary Thyroid Cancer Presenting with Incidental Skin Lesion: Critical Management of Distant Metastasis

Papillary thyroid cancer can usually metastasize to neck lymph nodes. Distant metastases are generally seen as solid organ metastases, in contrast, skin metastasis can rarely be seen. We present a case with papillary thyroid cancer diagnosed with skin metastasis as first clinical sign of distant organ metastasis.
A 63-year-old male patient admitted with a skin lesion in the left lateral neck. He had undergone subtotal thyroidectomy 14 years ago without relevant history of malignancy. Follicular variant papillary thyroid cancer was detected in the excisional biopsy performed from the cutaneous lesion. A 12 × 10 × 8 mm hyperechoic nodule in the left lobe was detected in USG and evaluated as Bethesta-III in fine needle aspiration biopsy. Bilateral multiple lung metastases were detected on thorax CT, trucut-biopsied from largest nodule and confirmed as metastasis. Carcinoma was not detected in total thyroidectomy, and post-operative multiple RAI therapies were applied.
Patients without history of thyroid cancer rarely present with skin metastases and thyroid cancer should not be overlooked in differential diagnosis. Despite meticulous evaluation of the thyroidectomy specimen, tumor may not be detected in the gland. Skin metastasis in papillary thyroid cancer should be evaluated as distant metastasis and investigations for other metastases should be done, and the treatment should be planned in a multidisciplinary manner.

Ýnsidental cilt lezyonu ile prezente olan papiller tiroid kanseri: Uzak metastazýn kritik yönetimi

Papiller tiroid kanseri genellikle boyun lenf bezlerine metastaz yapabilir. Uzak metastazlarý genellikle solid organ metastazý olarak görülmesine raðmen, çok nadiren cilt metastazý yapabilir. Bu çalýþmada uzak organ metastazýnýn ilk bulgusu olarak cilt metastazý ile baþvuran papiller tiroid kanserli olguyu sunmayý amaçladýk.
63 yaþýnda erkek hasta boyun sol lateralinde cilt lezyonu ile baþvurdu. 14 yýl önce subtotal tiroidektomi yapýlmýþ ve patolojisinde malignite saptanmamýþ olan hastanýn, yeni geliþen boyun sol lateralindeki lezyondan yapýlan eksizyonel biyopside foliküler varyant papiller kanser saptandý. Yapýlan USG’de sol lobta 12x10x8 mm hiperekoik nodülün ÝÝAB’si Bethesta 3 olarak deðerlendirildi. Toraks BT’de bilateral multipl akciðer metastazý ile uyumlu lezyon saptandý ve en büyük nodülden yapýlan trucut biyopsi metastaz ile uyumlu geldi. Total tiroidektomi yapýldý ve patolojide kanser saptanmadý. Hastaya postoperatif multipl RAÝ tedavisi uygulandý.
Tiroid kanseri öyküsü olmayan hastalar çok nadiren cilt metastazý ile prezente olabilirler ve ayýrýcý tanýda tiroid kanseri gözardý edilmemelidir. Cilt metastazýndan sonra yapýlan tiroidektomi spesimesinin dikkatli deðerlendirilmesine raðmen tiroidde tümör saptanmayabilir. Papiller tiroid kanserinde cilt metastazý uzak metastaz olarak deðerlendirilmeli ve diðer uzak metastazlar açýsýndan araþtýrýlmalý, tedavisi multidisipliner olarak planlanmalýdýr. (SETB-2021-05-150)